Medicines optimisation in care homes

Care homes must have a written policy and procedure on the administration of medicines. 

Staff working in the home should be aware of the policy and should be working to it at all times. Registered nurses must also work to The Code - Professional standards of practice and behaviour for nurses, midwives and nursing associates (NMC 2018). All aspects of how medicines are managed in the care home should be covered in the written policy.

The policy should include procedures for:

• obtaining medicines  
• storing and disposing of medicines 
• recording medicines
• action to be taken if a medicine administration error is identified 
• specialist procedures involving medicines relevant to that home. For example, the administration of percutaneous endoscopic gastrostomy (PEG) feeds/nutritional supplements.
• self administration.

Health care assistants (HCAs) or assistant practitioners (APs) and administration of medicines in care homes

If the care home is registered to provide nursing care then it should be the medical practitioner or registered nurse who administers medicines. However, in certain circumstances where health care assistants (HCAs) or assistant practitioners (APs) have been through the appropriate training and have been deemed to be competent then they may administer certain medicines. See: The Code section 11 -  Be accountable for your decisions to delegate tasks and duties to other people. 

Training for HCAs administering medicines in a care home

Appropriate staff members should be suitably trained in the administration of medicines and the homes policy should state how frequently training updates are accessed. National standards set out the requirements for the training of care staff in homes for older people and adults.

Self-administration of medication in a care home 

National standards place great emphasis on the right of a service user to take responsibility for their own medication when possible. Self-administration of medication is important in the promotion of self-management of long term conditions and should be supported wherever possible.

It is the responsibility of the registered manager to take a risk assessment of the situation. Part of the risk assessment is for the home to ensure that the service user understands that medicines must be locked away and to ensure this happens. There would be differing levels of monitoring that are required of the care staff in respect of the service user. This would be part of the ongoing risk assessment.

Medication records in a care home

There is a statutory requirement that medicines records be kept for all medicines in care homes. Detail can be found in the respective care homes regulations, children’s home regulations and the Independent Healthcare Regulations or the Regulation of Care (Scotland) Act 2001.  

Medicine Administration (MAR) Chart 

The Medicine Administration Record (MAR) chart is the working document which is signed to record administration of medicines. It should include all prescribed medicines and may also be used to record other medicines administered. For example, non-prescription medicines.

The chart must be signed and dated when the medicines are administered. The home should retain a list of staff members authorised to give medicines, which includes a record of their approved initials.